Pre-Nursing Degree Care Experience Pilot

Transcription

1 Allied Health Solutions Enterprise Innovation Partnership Pre-Nursing Degree Care Experience Pilot End of Evaluation Report Appendices

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3 CONTENTS Appendix 1- Guiding principles for the LETBs to manage the Pre-Nursing Degree Care Experience Pilot... 5 Appendix 2- Differentiating Research, Clinical Audit and Service Evaluation NIHR guidelines... Appendix 3 - The Economic Evaluation Metric... 7 Appendix 4 PNEP HCA Cohort 1 education qualifications... 8 Appendix 5 PNEP HCA Cohort 2 education qualifications... 9 Appendix Student nurses education qualifications... 1 Appendix 7 Care experience by percentage of respondents by clinical professional education programme Appendix 8 Number of students on clinical professional courses paid experience immediately prior to starting the course Appendix 9 Number of students on clinical professional courses unpaid experience immediately prior to starting the course Appendix 1 Number of students on clinical professional courses paid experience prior sometime in the past... 1 Appendix 11 Number of students on clinical professional courses unpaid experience prior sometime in the past Appendix 12 The period of time that students on clinical professional spent in paid care experience Appendix 13 The period of time that students on clinical professional spent in unpaid care experience Appendix 14 Numbers of hours per week that students on clinical professional spent in paid care experience... 2 Appendix 15 Numbers of hours per week that students on clinical professional spent in unpaid care experience Appendix 1 Details of PNEP HCA development support provided Appendix 17 Clinical areas where the HCAs have worked Appendix 18 Perceived benefits and challenges of the Pilot Scheme-Feb 19 th event... 2

4 Appendix 19 HCA s presentation about Cs Appendix 2 Detailed comparisons of paid and unpaid experience for all cohorts of nursing students

5 Appendix 1- Guiding principles for the LETBs to manage the Pre-Nursing Degree Care Experience Pilot Arrangements for the HCA pre-nursing degree care experience pilot Guiding principles LETBs must work in partnership with universities and employers to develop the bids. The employer(s) must have available paid HCA roles to recruit into. HCAs must be recruited for September, and will start their posts once the relevant checks and processes, eg DBS and induction, allow them to carry out their duties. As far as possible, HCAs should have the opportunity to receive a breadth of experience which should include care of older people. Recruitment and Selection Guiding principles HCA roles will be one-year fixed-term posts. HCAs will be employees of the partner service provider and subject to the normal rights and responsibilities as any other HCA employed under those terms. It should be made explicit to applicants that they need to have an interest in becoming a nurse, but would not be guaranteed a place on a nursing undergraduate programme on completion of their period of employment as an HCA on the pilot project. Applicants must meet the academic requirements for entry to a nursing undergraduate programme. HCAs should be recruited to the principles and values set out in the NHS Constitution. Induction, supervision and assessment Guiding principles The HCA roles must provide a quality and fulfilling experience through the methods and processes chosen for induction, supervision and assessment. HCAs must receive and successfully complete the employer s induction programme prior to carrying out their duties the induction should be in line with Skills for Health/Careminimum training standards published as part of the Government s response to the Francis inquiry and include how HCAs can raise concerns. There must be mechanisms of support and supervision available. HCAs should be regularly assessed to demonstrate values and behaviours eg against the Cs of care, compassion, competence, communication, courage and commitment including feedback from patients/carers. Supporting Pre-Nursing Degree Care Experience HCAs in their university application Guiding principles While HCAs will not be guaranteed a place on an undergraduate nursing programme, they should be guaranteed an interview at the partnering university(ies) subject to them meeting the normal university criteria for selection to interview for pre-registration nursing courses. HCAs should be supported in their application for university through identified educational needs, eg support in numeracy and literacy. 5

6 Appendix 2- Differentiating Research, Clinical Audit and Service Evaluation NIHR guidelines RESEARCH CLINICAL AUDIT SERVICE EVALUATION a. The attempt to derive generalisable new knowledge including studies that aim to generate hypotheses as well as studies that aim to test them. b. Quantitative research designed to test a hypothesis. Qualitative research identifies/explores themes following established methodology. c. Addresses clearly defined questions, aims and objectives. d. Quantitative research -may involve evaluating or comparing interventions, particularly new ones. Qualitative research usually involves studying how interventions and relationships are experienced. e. Usually involves collecting data that are additional to those for routine care but may include data collected routinely. May involve treatments, samples or investigations additional to routine care. f. Quantitative research - study design may involve allocating patients to intervention groups. Qualitative research uses a clearly defined sampling framework underpinned by conceptual or theoretical justifications. Designed and conducted to produce information to inform delivery of best care. Designed to answer the question: Does this service reach a predetermined standard? Measures against a standard. Involves an intervention in use ONLY. (The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference.) Usually involves analysis of existing data but may include administration of simple interview or questionnaire. No allocation to intervention groups: the health care professional and patient have chosen intervention before clinical audit. Designed and conducted solely to define or judge current care. Designed to answer the question: What standard does this service achieve? Measures current service without reference to a standard. Involves an intervention in use ONLY. (The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference.) Usually involves analysis of existing data but may include administration of simple interview or questionnaire. No allocation to intervention groups: the health care professional and patient have chosen intervention before service evaluation h May involve randomisation No randomisation No randomisation ALTHOUGH ANY OF THESE THREE MAY RAISE ETHICAL ISSUES, UNDER CURRENT GUIDANCE:- RESEARCH REQUIRES RESEARCH ETHICS COMMITTEE REVIEW AUDIT DOES NOT REQUIRE RESEARCH ETHICS COMMITTEE REVIEW SERVICE EVALUATION DOES NOT REQUIRE RESEARCH ETHICS COMMITTEE REVIEW

7 Appendix 3 - The Economic Evaluation Metric Cost/benefit Components Description Pilot management Project meetings and other national event costs HEE, including LETB staff s time Non HEE project management staff costs, for example evaluation costs Project management costs of other stakeholders such as university Recruitment The cost of promoting and advertising the pilots to potential participants Selection Employment costs Workplace additional support Education support Destination Short listing Interviews Earnings including allowances Occupational health, DBS and other checks Sickness and absence Productive contribution Supervision Mentors Practice facilitators Administrative costs Formal education programmes provided by HEIs, LETBs or employers specifically related to the PNEP Numeracy tests Numeracy support Participants may have: Left the scheme and NHS employment Not applied to a degree course but remained in NHS employment Applied successfully to HEIs Applied unsuccessfully to HEIs Yet to know their destination Project management costs are Input Costs associated with the establishment and running of the pilots that are unlikely to be replicated in the future. A range of approaches were used by areas including selection from students who had already applied to HEIs, adverts in local papers and on local radio. Measured in staff time Unlike students on placements PNEP participants are working in a wide range of settings in support roles contributing to service delivery and therefore providing a benefit to employers. Education costs relate to learning and development programmes, such as dementia awareness, that were delivered specifically because of the pilot. While not a requirement of the PNEP some areas did provide numeracy additional support. 7

8 Appendix 4 PNEP HCA Cohort 1 education qualifications Cohort 1- school qualifications Other 22 No school qualifications A levels / VCEs, 4+ AS levels, Higher School Certificate, Progression / Advanced Diploma Apprenticeship NVQ Level 2, Intermediate GNVQ, City and Guilds Craft, BTEC First / General Diploma, RSA Diploma 5+ O levels (passes) / CSEs (grade 1) / GCSEs (grades A*- C), School Certificate, 1 A level / 2-3 AS levels / VCEs, Higher Diploma NVQ Level 1, Foundation GNVQ, Basic Skills O levels / CSEs / GCSEs (any grades), Entry Level, Foundation Diploma Number of responses Cohort 1- vocational/higher qualifications Other 8 41 No vocational / higher qualifications 9 Other vocational / work-related qualifications 9 Professional qualifications (for example teaching, nursing, accountancy) 24 NVQ Level 4-5, HNC, HND, RSA Higher Diploma, BTEC Higher Level 43 Degree (for example BA, BSc), Higher degree (for example MA, PhD, PGCE) Number of responses NVQ Level 3, Advanced GNVQ, City and Guilds Advanced Craft, ONC, OND, BTEC National, RSA Advanced Diploma 8

9 Appendix 5 PNEP HCA Cohort 2 education qualifications Cohort 2- school qualifications Other 4 1 No school qualifications A levels / VCEs, 4+ AS levels, Higher School Certificate, Progression / Advanced Diploma Apprenticeship NVQ Level 2, Intermediate GNVQ, City and Guilds Craft, BTEC First / General Diploma, RSA Diploma O levels (passes) / CSEs (grade 1) / GCSEs (grades A*- C), School Certificate, 1 A level / 2-3 AS levels / VCEs, Higher Diploma NVQ Level 1, Foundation GNVQ, Basic Skills Number of responses 1-4 O levels / CSEs / GCSEs (any grades), Entry Level, Foundation Diploma Cohort 2- vocational/higher qualifications Other 8 No vocational / higher qualifications 9 4 Other vocational / work-related qualifications 3 2 Professional qualifications (for example teaching, nursing, accountancy) 11 NVQ Level 4-5, HNC, HND, RSA Higher Diploma, BTEC Higher Level 19 Degree (for example BA, BSc), Higher degree (for example MA, PhD, PGCE) Number of responses NVQ Level 3, Advanced GNVQ, City and Guilds Advanced Craft, ONC, OND, BTEC National, RSA Advanced Diploma 9

10 Appendix Student nurses education qualifications First year pre-registration student nurses- school qualifications 19 Other (eg equivalent qualifications from overseas countries) 2 No school qualifications A levels / VCEs, 4+ AS levels, Higher School Certificate, Progression / Advanced Diploma 7 Apprenticeship NVQ Level 2, Intermediate GNVQ, City and Guilds Craft, BTEC First / General Diploma, RSA Diploma 5 5+ O levels (passes) / CSEs (grade 1) / GCSEs (grades A*- C), School Certificate, 1 A level / 2-3 AS levels / VCEs, Higher Diploma 43 NVQ Level 1, Foundation GNVQ, Basic Skills Number of responses 1-4 O levels / CSEs / GCSEs (any grades), Entry Level, Foundation Diploma First year pre-registration student nurses- vocational/higher qualifications 1 Other (eg equivalent qualifications from overseas countries) 18 No vocational / higher qualifications 9 Other vocational / work-related qualifications 7 Professional qualifications 11 NVQ Level 4-5, HNC, HND, RSA Higher Diploma, BTEC Higher Level 25 Degree, Higher degree 5 NVQ Level 3, Advanced GNVQ, City and Guilds Advanced Craft, ONC, OND, BTEC National, RSA Advanced Diploma Number of responses 1

11 Appendix 7 Care experience by percentage of respondents by clinical professional education programme 5% 4% 3% 2% 1% % Adult Nursing 41% 23% 2% 1% 35% 3% 25% 2% 15% 1% 5% % Art Therapy 33% 33% 33% % 1% 8% % 4% 2% % Audiology 1% % % % Children's Nursing Clinical Psychology Diagnostic Radiography 35% 3% 25% 2% 15% 1% 5% % 31% 29% 23% 17% 5% 4% 3% 2% 1% % 42% 3% 14% 8% 7% % 5% 4% 3% 2% 1% % 1% 17% 14% 8% Dietetics Learning Disabilities Mental Health Nursing 5% 4% 3% 2% 1% 11% 43% 9% 37% 5% 4% 3% 2% 1% 4% Nursing 57% % 3% 2% 4% 5% 4% 3% 2% 1% 1% 2% 13% % % % 11

12 Midwifery Music Therapy Occupational Therapy 4% 3% 2% 1% % 3% 2% 22% 1% % 5% 4% 3% 2% 1% % 5% 5% % % 35% 3% 25% 2% 15% 1% 5% % 3% 3% 2% 2% Operating Department Paramedic Science Pharmacy 5% 4% 3% 2% 1% % Practice 38% 4% 44% 33% 22% % 3% 2% 1% 24% 2% 18% % 5% 4% 3% 2% 1% % 42% 2% 23% 1% Physiotherapy Podiatry Social Work 5% 4% 3% 2% 1% 15% 3% 15% 4% % 5% 4% 3% 2% 1% 14% 5% 27% 55% 5% 4% 3% 2% 1% 14% 3% 43% 7% % % % 12

13 5% 4% 3% 2% 1% % Speech and Language Therapy 17% 2% 17% 4% % 5% 4% 3% 2% 1% % Therapeutic Radiography 55% 38% 7% % 13

14 Number of Respondents Pre-Nursing Degree Care Experience-Appendices Appendix 8 Number of students on clinical professional courses paid experience immediately prior to starting the course Paid care to family members Paid care to friends 25 Paid care to neighbours 2 Worked in a health or social care setting

15 Number of responses Pre-Nursing Degree Care Experience-Appendices Appendix 9 Number of students on clinical professional courses unpaid experience immediately prior to starting the course Unpaid care to family members Unpaid care to friends 8 78 Unpaid care to neighbours I worked unpaid/volunteered in a health or social care setting

16 Number of respondents Pre-Nursing Degree Care Experience-Appendices Appendix 1 Number of students on clinical professional courses paid experience prior sometime in the past Paid care to family members Paid care to friends 2 Paid care to neighbours 15 Worked in a health or social care setting

17 Number of Respondents Pre-Nursing Degree Care Experience-Appendices Appendix 11 Number of students on clinical professional courses unpaid experience prior sometime in the past Unpaid care to family members Unpaid care to friends 15 Unpaid care to neighbours 1 I worked unpaid/volunteered in a health or social care setting

18 Number of Respondents Pre-Nursing Degree Care Experience-Appendices Appendix 12 The period of time that students on clinical professional spent in paid care experience Week to 5 Months 12 to 11 months 1 1 to 2 years 8 3 to 5 years 5 to 1 years years

19 Number of Respondents Pre-Nursing Degree Care Experience-Appendices Appendix 13 The period of time that students on clinical professional spent in unpaid care experience Week to 5 Months to 11 months 1 1 to 2 years 8 3 to 5 years 5 to 1 years 1 years

20 Number of Respondents Pre-Nursing Degree Care Experience-Appendices Appendix 14 Numbers of hours per week that students on clinical professional spent in paid care experience hours a week 9-24hours a week hours a week 4 or more hours a week

21 Number of Respondents Pre-Nursing Degree Care Experience-Appendices Appendix 15 Numbers of hours per week that students on clinical professional spent in unpaid care experience hours a week 9-24hours a week hours a week 4 or more hours a week

22 Appendix 1 Details of PNEP HCA development support provided Support 1 We held 3 x focus group support sessions on each site ( in total ) with participants to review their experiences and troubleshoot any issues. We were concerned to ensure that the participants were supported and that their progression to the programme was not jeopardised through potential negative experiences that went unsupported. 2 1 day per week in classroom with facilitators STEPS seminar and follow-up workshops Support from local FE with Apprenticeship scheme Buddy support = experienced mentor on their ward acts as knowledgeable friend Group tutorial with clinical education lead monthly Bespoke training in communication skills, dementia care and care of the dying/last offices 3 Each delegate attended a LETB funded workshop about the Cs and NHS Values and beliefs ( 1 day per participant) undertook a bespoke self-awareness, resilience programme ( 5 days per participant) Attended regional and national launch day ( 2 days per participant) Attended 2 HEE focus groups ( 2 days per participant) Attended Apprenticeship Level 2 education programme within Trust ( days variable - Trusts will detail costs) 4 Support for personal statement writing for a couple of PNEPs who found this difficult. 5 Some pastoral support was required for 3 of the 5 HCAs. This took approximately 1. days Regular meetings 7 There was a mixed model of support provided, including some working in a single point of the service and others being rotated through a number of areas. In addition we also have provided 3 group meetings of all HCAs on the pre nursing programme, facilitated by HENE, which has provided learning and development for the group covering a number of aspects, namely introduction to dementia care, team working, support for the application process to university 22

23 Appendix 17 Clinical areas where the HCAs have worked Clinical setting/ward Numbers of months Acute psychiatric ward 11 Acute psychiatric ward 11 Comment/additional experience e.g rotation Acute stroke ward Coronary care ward Acute stroke ward Coronary care ward Acute and elderly care ward Gynaecology and gynaecological surgery Acute oncology and palliative care ward 12 Cardio-respiratory medicine ward 9 Cardiology ward 1 2 weeks minor injuries Unit 2 weeks emergency admissions ward Clinical decision unit 1 Clinical decision unit 1 Clinical decision unit 1 Community setting 9 2 weeks emergency assessment unit 2 weeks walk in centre 2 weeks cardiology Community learning disabilities Neurological inpatient ward Neurological outpatient ward Dementia ward Respiratory ward Dementia Diabetes and acute medicine ward Children s ward Stroke and dementia ward Diabetes and general medicine ward Elderly care ward Ear, nose and throat ward 9 Elective surgery 1 Elderly care ward 9 Elderly care ward 1 Elderly care ward 11 1 day shadowing areas of choice: children s wards: day surgery, Neonatal intensive care unit, Paediatric intensive care unit. 23

24 Elderly medicine ward 2 Dementia ward 3 Diabetes and general medicine ward 5 Emergency surgery 11 Gastrointestinal ward 9 Gastrointestinal ward 1 Gastrointestinal ward 1 Gastrointestinal ward 12 Gastrointestinal ward 7 High Dependency Unit 11 Liver medicine and surgery ward 12 Maternity department 12 1 day A&E (requested and unpaid) Medical short stay ward 1 1 day on the children s ward Mental Health- Rehabilitation and Recovery Unit Mental Health- Rehabilitation and Recovery Unit Mental Health- Rehabilitation and Recovery Unit Mental Health- Rehabilitation and Recovery Unit Minor Injuries Unit 1 2 weeks district nursing 2 weeks cardiology 2 weeks Emergency Assessment Unit Neurosurgical ward 12 Neurology ward Older people s medicine Acute Medical Unit Oncology ward 12 Oncology ward 7 Oncology ward 11 1 day ophthalmology 1 day gastroenterology Orthopaedic ward 9 Orthopaedic rehabilitation ward 1 Planned short stay unit Planned short stay unit Rehabilitation ward 1 Rehabilitation ward 9 Respiratory ward 11 Respiratory ward 9 Respiratory ward 9 Respiratory ward Dementia ward 1 day chemotherapy outpatient department 24

25 1 day urology department Stroke rehabilitation ward 12 Stroke ward 11 Surgical ward Care of the elderly ward Surgical Assessment Unit 9 1 day - care of the elderly Transplant ward 1 Trauma and orthopaedic ward 11 Trauma and orthopaedic ward 11 Trauma and orthopaedic ward 9 2 days gynaecology clinic 1 day acute medical unit Trauma and orthopaedic ward Medical Assessment Unit Urology Vascular surgery ward Colorectal surgery ward 25

26 Appendix 18 Perceived benefits and challenges of the Pilot Scheme-Feb 19 th event Benefits Challenges Attrition -12 Co-ordinating the start of the pilot and the recruitment cycle because of time pressures -5 Experience of nursing care-2 Communication about the scheme in the trusts - 13 Insight into a caring career-19 Different guarantees by the university sector- For other HCAs-2 Broken promises -4 Increased confidence of the participants-13 Unstable workforce churn-5 Ensuring quality of staff who go on to train as a Vulnerable trainees learning bad practice-3 nurse- Time to focus on the fundamentals Cs-12 Fitting into the ward-1 Paid while getting care experience - Inconsistent offer of courses -3 Learn about the NHS-3 Resource intensive- Learn to adapt-1 Speed of implementation-2 Learn to adapt and be empathetic-1 One placement very limiting experience-4 Learn about shift working-1 Inconsistent clinical experience- Collaborative work between HEIs and Trusts-1 No chance to shadow a nurse-1 Improve patient centred care-8 Inconsistent implementation-7 Support with uni applications Insufficient HCA vacancies-2 Develop resilience-1 Ward staff allowing the HCAs to attend study days-1 Potential to use PNEP as part of accredited Lack of clarity of role-1 training pathways-1. Develop communication skills-3 Other learners in the clinical setting-2 Help with university application-3 Collaboration between Trust and HEI No buddy/mentor- Losing good staff-3 Different entry into university standards Emotional Variable employment status -3 Sustainable/scalable model-5 Adds another year to training-1 Destabilise HCA workforce-3 2

27 Appendix 19 HCA s presentation about Cs Being a young adult, Care, Compassion, Communication, Competence, Courage, Commitment are not foremost on your mind. I don't wait up and suddenly go...'today I am going to be courageous' and if you do you should be some kind of superhero. When I first started the PNEP scheme, I was not aware what the Cs were or the importance of them. I knew naturally that I was caring and compassionate and I have always wanted to help others. I knew that the relationships I built with people I care about are based on respect, empathy and dignity. I could also communicate well, and by that I mean I could talk...the idea of being able to communicate without speech was beyond me. So that's Care and Compassion, I'll come back to Communication in more detail in a moment. Now for, Competence, Courage and Commitment. The ones that DID NOT come naturally. I am currently working on a Neuro-Rehabilitation unit, where I am faced with complex and challenging behaviours every day. I am able to build a positive rapport with the patients as they stay with us for a number of weeks. When I first stood on the ward, all I kept thinking was how am I ever going to become competent to do this? To start off with there were so many things to remember, so much to learn. If I am honest the first week just went straight over my head. I really didn't know how to be confident in this environment. I had never been an outgoing, confident person to begin with, I was full of self-doubt. I didn't want to be that person anymore, so in the early weeks, I realised I had to push myself quickly. Competence requires practice. And when I became more competent the more confident I became. I believe that when competence comes confidence will follow. They work hand in hand with each other. Once you've grasped one you get the other. The next to follow was Courage. Again, I never believed I was a courageous person. I always thought courage had to be some huge gesture. I have been extremely lucky to have 2 mentors, and a fantastic ward manager. Sadly one of my team has moved on with her career, but she is still in contact with me and still gives me great advice. However, my mentor and my ward manage well in fact the whole team, have given me the support and the encouragement I've needed to progress and learn new skills. They have become friends, they give me confidence boosts when I need them, they reassure me that I'm doing a great job and have given me the courage to believe in myself and speak out when I feel necessary. I know now that having courage does not mean you have to carry out a massive gesture, but it is the simplest acts of courage that encourage change, therefore ultimately delivering a better quality of care. It DOES NOT take a superhero to do this! Commitment, I find committing hard to do; it doesn't come easily for me. The last few months have been a whirlwind. I've had highs and lows. It's been an emotional roller coaster, I am in tears one minute and laughing my head off the next. There have been times when I have doubted my commitment to my ambition. Is this really me? Can I do this? Can I see myself doing this for the rest of my life? The more I learn now, the more committed I become. It is with thanks to PNEP, and the opportunity it has given me to slide that this is what I want to do. I am committed. So, what have I learnt? My partner asked me this one evening... My response was quite simply, 'I learnt how to communicate' I then got the oddest look. I knew I could talk, but when faced with people that couldn't communicate 27

28 in this way, I realised that in actual fact my communication skills were very poor. I had to adapt and find new ways of communicating. I had to learn how to use non-verbal ways, such as pictorial charts and alphabet charts. I've also learnt how to read body language and facial expressions more effectively. This is the most valuable lesson I have learnt. Without effective communication we cannot deliver even the most basics of care properly., along with many of us I the room have taken the ability of verbal communication for granted. I've one patient who came to the ward unable to communicate verbally and left being able to speak with basic words and sentences. For the purposes of this presentation I will call her Jane. Wen Jane was admitted, I w worried that I wouldn't be able to help her; it was with jane that I learnt how to use the alphabet board. A first it required a lot of patience with not just me but with Jane too. Sometimes I could see she was getting frustrated and I would get frustrated at myself too. I persevered with Jane and the more I was with her, the more rewarding it was. Because I took time to adapt to Jane's needs she came to trust me to provide the care she required. By the time Jane was ready to go home, we were both laughing and joking with each other and able to have a conversation; she had even given me a nickname. I cannot tell you in words how rewarding it was to see Jane progress and to now that I played an important role in her rehabilitation. So that is the Cs in my world as I know it now. As an aspiring nurse, the Cs are definitely foremost in my mind now. I believe that the Cs are the fundamental foundations of becoming a great nurse. It is the collaboration of the Cs that define our values and behaviours. They have given me a better understanding of the hope of nurse I aspire to be and how my actions can be passed on to others. I have learnt a lot about myself and who I really am. I have found my niche. I can now say I am confident and have masses of self-belief. Who would have thought a year ago I would be standing here today in front of you, telling you my experience so far. Just look at me now. I cannot wait for the future! Thank you all for listening to my story and a massive thank you to those who made it possible. 28

29 Appendix 2 Detailed comparisons of paid and unpaid experience for all cohorts of nursing students Cohort of respondents A Cohort 1-PNEP HCAs (n=27) B Cohort 2-PNEP HCAs (n=1) C First year student nurses at partner universities (adult field) (n=3) D First year clinical professional students studying in England (n=94) Adult nursing student subgroup of cohort D (n=452) Children s nursing student subgroup of cohort D (n=5) Mental health student subgroup of cohort D (n=117) Learning disabilities nursing student sub-group of cohort D (n= 15) Immediately prior to family (%) Immediately prior to friends (%) Immediately prior to neighbours(%) Immediately prior worked in health or social care setting (%) (%)

30 Cohort comparisons of previous paid care experience in the past Cohort of respondents A Cohort 1-PNEP HCAs (n=25) B Cohort 2-PNEP HCAs (n=7) C First year student nurses at partner universities (adult field) (n=24) D First year clinical professional students studying in England (744) Adult nursing student subgroup of cohort D (n=35) Children s nursing student subgroup of cohort D (=43) Mental health student subgroup of cohort D (n=8) Learning disabilities nursing student sub-group of cohort D (n=8) In the past to family (%) In the past to friends (%) In the past to neighbours(%) In the past worked in health or social care setting (%) (%)

31 Cohort comparisons of previous unpaid experience immediately prior to taking up current role/position Cohort of respondents A/ Cohort 1-PNEP HCAs (n=24) B/ Cohort 2-PNEP HCAs (n=8) C/ First year student nurses at partner universities (adult field) (n=17) D/ First year clinical professional students studying in England (n=58) Adult nursing student subgroup of cohort D (n=218) Children s nursing student subgroup of cohort D (n=59) Mental health student subgroup of cohort D (n=33) Learning disabilities nursing student sub-group of cohort D (n=5 ) Immediately prior to family (%) Immediately prior to friends (%) Immediately prior to neighbours(%) Immediately prior worked in health or social care setting (%) (%)

32 Cohort comparisons of previous unpaid care experience in the past Cohort of respondents A Cohort 1-PNEP HCAs (n=5) B Cohort 2-PNEP HCAs (n=1) C First year student nurses at partner universities (adult field) (n=5) D First year clinical professional students studying in England (n=957) Adult nursing student subgroup of cohort D (n=47) Children s nursing student subgroup of cohort D (n=) Mental health student subgroup of cohort D (n=8) Learning disabilities nursing student sub-group of cohort D (n=9) In the past to family (%) In the past to friends (%) In the past to neighbours(%) In the past worked in health or social care setting (%) (%)

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